Biomedical subjects
J Michael McCoy
Publications and source records attributed to J Michael McCoy.
From PACS to integrated EMR.
The integration of medical images as part of the patient record has always been a critical component of documentation and information supporting clinical decisions. In the past two decades the increased number of imaging procedures that allows a more accurate and more specific diagnosis has significantly increased and their role in patient management has grown rapidly. With the evolution toward digital modalities and management of medical images in a fully digital environment with the deployment of enterprise wide Picture Archiving Communication Systems (PACS) a wider and more rapid access to the images by referring physicians and clinicians has become possible. The parallel evolution of electronic medical records (EMR) supporting all other documents and clinical data in electronic format led to the necessity of integrating medial image data with the rest of the patient record. Although the marriage of medical images and patient record data in electronic format seems a very natural and necessary combination it has often been very slow in development due to the lack of standardization and clear understanding of clinical workflows and clinical requirements. Several early implementations demonstrated the added value of combining medical images with the patient record and have shown that the availability of data and images facilitates and improves the accuracy and efficiency of patient management. Recent efforts in industry and the academic community to harmonize and improve the integration of medical images with patient record, with the promotion of new standards and better definitions of clinical workflows and standard mechanism of integration of different types of data into unified data models, has facilitated the deployment of modern EMR. Also, a shift in paradigm due to recent technological revolutions such as the development of the World Wide Web and the concepts of portal servers for accessing data for multiple sources has significantly boosted the trends into open systems which allows easier and more functional integration of medical data from different sources. Furthermore, the emergence of a new strategy for software development, based on open source components, allows software programs to be shared and exchanged between different institutions leading to more rapid deployment of standardized electronic patient record.
Open Source software in medical informatics--why, how and what.
'Open Source' is a 20-40 year old approach to licensing and distributing software that has recently burst into public view. Against conventional wisdom this approach has been wildly successful in the general software market--probably because the openness lets programmers the world over obtain, critique, use, and build upon the source code without licensing fees. Linux, a UNIX-like operating system, is the best known success. But computer scientists at the University of California, Berkeley began the tradition of software sharing in the mid 1970s with BSD UNIX and distributed the major internet network protocols as source code without a fee. Medical informatics has its own history of Open Source distribution: Massachusetts General's COSTAR and the Veterans Administration's VISTA software have been distributed as source code at no cost for decades. Bioinformatics, our sister field, has embraced the Open Source movement and developed rich libraries of open-source software. Open Source has now gained a tiny foothold in health care (OSCAR GEHR, OpenEMed). Medical informatics researchers and funding agencies should support and nurture this movement. In a world where open-source modules were integrated into operational health care systems, informatics researchers would have real world niches into which they could engraft and test their software inventions. This could produce a burst of innovation that would help solve the many problems of the health care system. We at the Regenstrief Institute are doing our part by moving all of our development to the open-source model.
Expansile lesion of the mandible in a 45-year-old woman.
Explore the source record for details and available documents.
The oral and maxillofacial surgeon's role in the diagnosis and treatment of oral cancer.
Explore the source record for details and available documents.
Use of personal digital assistants for retrieval of medical images and data on high-resolution flat panel displays.
For its new acute care hospital, the University of California at Los Angeles is evaluating innovative technology involving high-resolution flat panel display devices configured as "network appliances" that can be wall mounted for use in the retrieval and display of medical images and data. Physicians and healthcare providers can log on with wireless handheld computers, which can serve as an identification device as well as a navigational tool for selecting patient records and data. These data are displayed and manipulated on the flat panel display without the need for a keyboard or mouse. A prototype was developed with commercially available image display software, which was modified to allow the remote control of software functions from a handheld device through an infrared communication port. The system also allows navigation through the patient data in a World Wide Web-based electronic patient record. This prototype illustrates the evolution of radiologic facilities toward "shareable" high-quality display devices that allow more convenient and cost-effective access to medical images and related data in complex clinical environments, resulting in a paradigm shift in data navigation and accessibility.